PHARMACY PROVIDERS, PLEASE NOTE!!!

If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.

Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the Medicaid program. Participation may be verified in Appendix C, available at http://www.lamedicaid.com. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

2016 Annual 1099 Notice for Providers

Louisiana Medicaid 2016 1099s will be distributed by U.S. Mail on or before January 24, 2017. Electronic copies are now available for download by going to the Louisiana Medicaid web site, www.lamedicaid.com, Secure Portal, application link, Online 1099. If replacement copies or additional copies are needed, providers must print them from the web site. If you feel there is an error on your 1099, please contact Molina Provider Enrollment at 225-216-6370. Prior year 1099’s will be stored in the archive on www.LaMedicaid.com.

Attention Medicaid Fee For Service (FFS) Professional Providers, Independent Laboratory Providers, Take Charge Plus Providers and Outpatient Hospital Providers

Papanicolaou test (Pap Test) Revised

Effective with dates of service January 1, 2017 and forward, Louisiana Medicaid will no longer reimburse for routine cervical cancer screening for recipients under the age of 21 years.

However, Medicaid considers cervical cancer screening medically necessary for recipients under age 21who have the following conditions/diagnosis:

  • Recipients who were exposed to diethylstilbestrol before birth
  • Human Immunodeficiency Virus (HIV)
  • A weakened immune system
  • History of cervical cancer
  • Other criteria subsequently published by American Congress of Obstetricians and Gynecologists (AGOG).

Outside of these ACOG guidelines, Louisiana Medicaid will cover repeat Pap tests for recipients under the age of 21 that are being treated for abnormal cervical cancer screening test results prior to January 1, 2017.

Providers of these recipients must submit hard copy supporting documentation to the fiscal intermediary. Required documentation includes, but is not limited to:

  • Initial abnormal Pap test result and subsequent abnormal Pap test results
  • History and Physical
  • Procedure/Progress note

For those recipients under the age of 21, it is the responsibility of the treating provider to submit the required documentation needed for billing to the laboratory provider upon testing.

Providers of these services must submit hard copy supporting documentation to the fiscal intermediary to have the age restriction bypassed as necessary.

Claims filed with hard copy supporting documentation to the fiscal intermediary will pend Medical Review for confirmation of the conditions that are considered medically necessary.

  • If the hard copy documentation is not present, the claim for the test will be denied.
  • If the hard copy supporting documentation is present and meets the clinical criteria, the claim will be allowed to continue normal processing.

Updates to Healthy Louisiana related systems and claims processing are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan. Fee For Service (FFS) policy updates to follow. Questions regarding FFS Medicaid should be directed to Molina Provider Relations at 1(800) 473-2783 or (225) 924-5040.

ATTENTION: Eligible Providers

Are you a Medicaid provider with a Certified EHR system? If so, it’s NOT too late to receive up to $63,750!! The deadline to attest to AIU and MU has been extended to March 31, 2017! Current and new Medicaid Providers who have purchased an EHR by December 31, 2016 are eligible. For more information on the Medicaid EHR Incentive program, email us at: ehrincentives@la.gov or Call a Medicaid EHR Specialist at 225-342-4810 or 225-342-7742.

Attention Louisiana Medicaid Providers:

Effective Februmy 14, 2017. Fee-for-Service (FFS) Medicaid will have Point of Sale (POS) edits for cariprazine (Vraylar®) pharmacy claims.

Please refer to www.lamedicaid.com for more information.

Attention Louisiana Medicaid Providers:

Effective Februmy 14, 2017. Fee-for-Service (FFS) Medicaid updated the ICD-10-CM diagnosis code requirements for adalimumab (Humira®) and abobotulinumtoxinA (Dysport®) pharmacy claims.

Please refer to www.lamedicaid.com for more information.

Attention Louisiana Medicaid Providers:

Effective Februmy 14, 2017. Fee-for-Service (FFS) pharmacy claims for perampanel (Fycompa®) will have Point of Sale (POS) edits and FFS pharmacy claims for sacubitril/valsartan (Entresto®) will require clinical pre-authorization.

Please refer to www.lamedicaid.com for more information.